ORIGINAL RESEARCH article
Front. Oncol.
Sec. Head and Neck Cancer
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1577901
Pre-Treatment Anemia in Head and Neck Cancer: Risk Factors, Subtypes, and Survival Outcomes Author information
Provisionally accepted
Cornelius Kürten1*
Vinithagowry Sivakumar1Sebastian Waßenberg2
Marie Carolin Schleupner1Valentin Funk1Elena Lazzarini1Sara Aksu1
Maja Guberina1
Thomas Christoph Gauler3
Martin Stuschke3Stefan Mattheis1
Stephan Herbert Lang1Timon Hussain1,4- 1Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Essen, North Rhine-Westphalia, Germany
- 2punkt05 Statistikberatung, Düsseldorf, Germany
- 3Department of Radiotherapy, University Hospital Essen, Essen, North Rhine-Westphalia, Germany
- 4Department of Otolaryngology, Head and Neck Surgery, School of Medicine and Health, Technical University of Munich, Munich, Bavaria, Germany
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Introduction: Anemia in head and neck cancer (HNC) may be due to additive, overlapping or competing causes. Here we aim to investigate the prevalence of pre-therapeutic anemia, associated risk factors, subtypes, and impact on survival among HNC patients, including the clinically relevant subgroups of HPV-associated HNC: Materials and Methods: A retrospective chart review of HNC patients diagnosed between 2010 and 2020 identified a study cohort of 921 patients. Every patient was subject to pre-therapeutic laboratory testing which was correlated with clinical data and oncologic outcomes.Results: Pre-therapeutic anemia was present in 18.1% of patients with advanced age, low BMI, systemic inflammation, and kidney dysfunction being significant risk factors for anemia. For oropharyngeal cancers, p16+ status was associated with lower anemia prevalence and offset the impact of smoking history on anemia risk when compared to all HNC patients. 19.2% of patients were hypochromic-microcytic and 4.2% were hyperchromic-macrocytic, indicative of iron or vitamin B12/ folate deficiency, respectively. Even mild anemia (11-12.9 g/d) was associated with a survival disadvantage compared to non-anemic patients (64% vs. 85% overall survival, <0.001).Anemia is a significant negative survival predictor in HNC patients, with severity affecting prognosis. A relevant subgroup of patients had potentially reversible anemia subtypes, early identification and treatment of which may improve outcomes.
Keywords: cancer associated anemia, head and neck cancer, Squamous cell carcinoma, HPV+ oropharyngeal cancer, iron deficiency, Macrocytic anemia, Vitamin B12, folate Declarations Author's contributions: Conceptualization: C.H.L.K., T.H.
Received: 16 Feb 2025; Accepted: 26 May 2025.
Copyright: © 2025 Kürten, Sivakumar, Waßenberg, Schleupner, Funk, Lazzarini, Aksu, Guberina, Gauler, Stuschke, Mattheis, Lang and Hussain. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Cornelius Kürten, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Essen, North Rhine-Westphalia, Germany
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